title: Does symptom onset to primary stroke center time goals affect stroke outcome?
abstract: BACKGROUND
  Treating acute ischemic stroke (AIS) within 4.5 hours and door-to-needle time of less than 60 minutes may optimize recovery. It is unknown if onset to Primary Stroke Center (PSC) time goals affect outcome. The purpose of this study was to examine effects of symptom onset to PSC time goals on outcome.
  
  
  METHODS
  Analysis included prospectively collected data from the University of California San Diego Specialized Program of Treatment Research in Acute Stroke. All AIS patients treated with intravenous recombinant tissue plasminogen activator were included if treated within 270 minutes, and 90-day modified Rankin Scale (mRS) score was known. Primary outcome of the 90-day mRS was analyzed using multivariable logistic regression. Good outcome was defined as a 90-day mRS score of 0-2. Variables assessed were time from onset to arrival, stroke code, neurologic exam, imaging, laboratories, treatment decision, and treatment (by quartiles).
  
  
  RESULTS
  Two hundred ninety-one patients were included (49.8% female, mean age 70.6 ± 16.1, median National Institutes of Health Stroke Scale 10, SD = 8.5). Good outcome occurred in 45% of patients. Significant baseline differences included HTN (P ≤ .001), A fib (P ≤ .001), prestroke mRS (P < .001), and Hispanic ethnicity (P = .011). Comparing good with poor outcome groups: mean onset to arrival was 70.6 min versus 62.5 min (P = .129) and mean onset to treatment was 140.1 min versus 134.9 min (P = .118). Controlling for prespecified covariates, no PSC time goals were significant predictors of the 90-day outcome.
  
  
  CONCLUSIONS
  In our Comprehensive Stroke Center (CSC), onset to PSC time goals were not significant predictors of the 90-day outcome. Expedited care processes in CSC may compensate for differences in outcome. These results should be validated in a larger cohort and in PSCs versus CSCs.
authors.affiliation: University of California San Diego Neurosciences Department. Electronic address: bhfchee@gmail.com.
authors.forename: Bryant
authors.initials: B
authors.lastname: Chee
authors.affiliation: University of California San Diego Department of Family and Preventative Medicine, San Diego, California.
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.affiliation: University of California San Diego Department of Family and Preventative Medicine, San Diego, California.
authors.forename: Karin
authors.initials: K
authors.lastname: Ernstrom
authors.affiliation: University of California San Diego Neurosciences Department.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Guzik
authors.affiliation: University of California San Diego Neurosciences Department.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hemmen
authors.affiliation: University of California San Diego Neurosciences Department.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Rapp
authors.affiliation: University of California San Diego Neurosciences Department.
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
authors.affiliation: University of California San Diego Neurosciences Department.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002140:California; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: CSC; PSC; Stroke; outcome; research; treatment